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Book review: The FRAYED consultation model by Dr Deen Mirza

This is a great book, I am sure it will rapidly become very popular not just with doctors and nurse practitioners but also with practice managers. It focuses on the real current world of primary care where many consultations are with patients new to the clinician and focus on unrealistic demands.

Cosy models developed when most consultations were with established GP principals who already knew their patients are acknowledged to have incomplete relevance. The book focuses on a simple mnemonic acronym FRAYED to illustrate ways to proceed when from the outset the consultation is set to be challenging. Realistic advice is given on yielding early to demand rather than the emotionally disturbing scenario where clinicians have to give in after already becoming upset and cornered by the circumstances. The advice given helps protect the clinician and there are links to advice web pages that assist with developing resilience.

The author is experienced both as a clinician and trainer and the whole advice given is complete and down to earth. There are some scenarios described where the consequence of a complaint becomes almost inevitable, and the need for a realistic understanding of this and support for the clinician is discussed. Managers dealing with complaints would do well to read this book particularly those new to primary care. Experienced clinicians will find reading it therapeutic as the vividly described realistic interactions are good to process as an objective third part, in the light of the author’s well thought-through coping strategy.

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It’s short enough to read through over a short lunch break, and would make a great focus for a meeting. The book does not cover scenarios linked to addictions work, although much of the advice would be relevant.

Even if you don’t normally bother with books you will want to look through this one.


Dr Grace Gibson is a GP in Hull